Active NPI
State of Missouri
Doing business as Southeast Missouri Residential Services-Sikeston
- Intellectual Disabilities Intermediate Care Facility
- Sikeston, MO
National Provider Identifier
1598844029
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual Disabilities Intermediate Care Facility
- License
- EXEMPT
- Legal business name
- STATE OF MISSOURI
- Doing business as
- Southeast Missouri Residential Services-Sikeston
- Practice address
- 112 Plaza Dr
Sikeston, MO 63801-5137 - Phone
- (573) 472-5300
- Fax
- (573) 472-5308
- NPI assigned
- Nov 3, 2006
- Last updated
- Oct 27, 2020
- Organization subpart
- Yes
- Parent organization
- STATE OF MISSOURI
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Molly Jane Boeckmann
- Title
- Director of Administrative Services
- Phone
- (573) 751-4055
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Intellectual Disabilities Intermediate Care Facility | 315P00000X | EXEMPT | MO | Primary |
Addresses
Primary practice location
112 Plaza Dr
Sikeston, MO 63801-5137
Mailing address
PO Box 687
Jefferson City, MO 65102-0687
Phone (573) 751-3398
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 051793206 | Medicaid | MO |
Other names 1
- Southeast Missouri Residential Services-Sikeston
National Provider Directory
National Provider Directory- Tax ID family
- Missouri Tuberculosis Lab
- Part of
- Missouri Tuberculosis Lab
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Poplar Bluff, MO
- NPI 1568601482
-
dba Hannibal Regional Center
- Developmentally Disabled Services Day Training Agency
- Hannibal, MO
- NPI 1487714515
-
dba Hawthorn Children's Psychiatric Hosptial
- Psychiatric Residential Treatment Facility
- Saint Louis, MO
- NPI 1487721379
-
dba Higginsville Habilitation Center-Crisis
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Higginsville, MO
- NPI 1487931358
-
dba Marshall Habilitation Center-Home 1
- Developmentally Disabled Services Day Training Agency
- Marshall, MO
- NPI 1518027127
-
dba Nevada Habilitation Center-Crisis
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
- Nevada, MO
- NPI 1528333085
-
dba Southeast Missouri Residential Services-Sikeston Prof Grp
- Family Medicine Physician
- Sikeston, MO
- NPI 1528348430
-
dba Central Missouri Regional Center
- Developmentally Disabled Services Day Training Agency
- Columbia, MO
- NPI 1548322605
-
dba St Louis Forensic Treatment Center
- Psychiatric Hospital
- Saint Louis, MO
- NPI 1578518239
-
dba Kirksville Regional Center
- Developmentally Disabled Services Day Training Agency
- Kirksville, MO
- NPI 1578623609
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Internal Medicine Physician
- Poplar Bluff, MO
- NPI 1780065615
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162512000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1603756800000",
"number": "1598844029",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 687",
"city": "JEFFERSON CITY",
"state": "MO",
"postal_code": "651020687",
"telephone_number": "573-751-3398",
"fax_number": "573-526-4560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 PLAZA DR",
"city": "SIKESTON",
"state": "MO",
"postal_code": "638015137",
"telephone_number": "573-472-5300",
"fax_number": "573-472-5308"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "STATE OF MISSOURI",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "STATE OF MISSOURI",
"enumeration_date": "2006-11-03",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A",
"authorized_official_last_name": "BOECKMANN",
"authorized_official_first_name": "MOLLY",
"authorized_official_middle_name": "JANE",
"authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATIVE SERVICES",
"authorized_official_telephone_number": "573-751-4055"
},
"taxonomies": [
{
"code": "315P00000X",
"taxonomy_group": "",
"desc": "Intermediate Care Facility, Intellectual Disabilities",
"state": "MO",
"license": "EXEMPT",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "051793206",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Southeast Missouri Residential Services-Sikeston",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Southeast Missouri Residential Services-Sikeston",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sikeston, MO
- St. Louis JC Vamc
- Donna Lee Stallings, MAED, CCC-SLP
- State of Missouri (Sikeston Regional Center)
- State of Missouri (Sikeston Regional Center)
- State of Missouri (Southeast Missouri Residential Services-Sikeston Prof Grp)
- Lindsey Rachell Steele, COTA
- Jennifer Marie Steelman, M.A.,CCC-SLP
- James Dylan Stephens, PA-C
- Mary Deann Stephens, NP
- Morgan Renee Stephens
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.